Citation Information :
Mishra N, Mishra R. Clinicobiochemical Analysis of Polycystic Ovary Syndrome and Metabolic Syndrome: Do They Go “Hand in Glove”?. J South Asian Feder Obs Gynae 2022; 14 (1):29-34.
Aims and objectives: To study the clinical and biochemical markers for metabolic syndrome in women diagnosed with polycystic ovary syndrome (PCOS).
Materials and methods: This is an observational (cross-sectional) study involving 105 patients of PCOS, carried out over 2 years (2018–2020) in a tertiary care hospital of Berhampur, Odisha. Weight, height, waist circumference, hip circumference, and blood pressure were measured. The W to H ratio (WHR) and body mass index (BMI) was calculated. Venous blood samples were collected after an overnight fast for glucose, serum triglycerides, and high-density lipoprotein- cholesterol. A 2-hour 75 g glucose tolerance test was done, along with fasting insulin. Homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. Statistical analysis was performed by the SPSS program for Windows (v 25.0). Tests of significance were carried out.
Results: The patients fell into the age range of 16–30 years. The average body mass index (BMI) was 27 ± 5.3 kg/m2, with central obesity in 40% cases. Thirty-seven patients (35.2%) fulfilled three or more criteria of metabolic syndrome, maximum cases (49%) in the age group of 20–24 years. Central obesity (Waist circumference ≥80 cm) is the most deranged parameter among 32/37 (86.5%) followed by dyslipidemia—serum HDL-C ≤50 mg/dL in 27/37 (73%). Fasting plasma glucose levels are least deranged in 43.2% of cases (16/37). Women with PCOS had a significant association with all parameters of metabolic syndrome (p ≤0.05).
Conclusion: Several studies have proved a consistent association between PCOS and metabolic dysfunction. It is, thus, imperative to screen every case of PCOS, with appropriate follow-up, to catch derangements at the earliest. Encouraging healthy lifestyle practices is important to improve ovulatory and menstrual symptoms as well as prevent future morbid metabolic ailments.
Allahbadia GN, Merchant R. Polycystic ovary syndrome in the Indian subcontinent. Semin Reprod Med 2008;26(1):22–34. DOI: 10.1055/s-2007-992921.
Joshi B, Mukherjee S, Patil A, et al. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab 2014;18(3):317–324. DOI: 10.4103/2230-8210.131162.
The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19(1):41–47. DOI: 10.1093/humrep/deh098.
Athyros VG, Ganotakis ES, Tziomalos K, et al. Comparison of four definitions of the metabolic syndrome in a Greek (Mediterranean) population. Curr Med Res Opin 2010;26(3):713–719. DOI: 10.1185/03007991003590597.
Kasper DL, Fauci AS, Hauser S, et al., editors. Harrison's principles of internal medicine, 19th ed. New York: The McGraw-Hill Companies, Inc; 2015.
Moghetti P, Tosi F, Bonin C, et al. Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 2013;98(04):E628–E637. DOI: 10.1210/jc.2012-3908.
Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic hyperinsulinaemic clamp. Hum Reprod 2013;28(3):777–784. DOI: 10.1093/humrep/des463.
Garg R, Malhotra J, Singh S, et al. Relationship between vitamin D and insulin resistance in polycystic ovary syndrome women. J South Asian Feder Obst Gynae 2017;9(3):211–215. DOI: 10.5005/jp-journals-10006-1497
Ehrmann DA, Liljenquist DR, Kasza K, et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2006;91(1):48–53. DOI: 10.1210/jc.2005-1329.
Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome and type 2 diabetes mellitus. Fertil Steril 2002;77(6):1095–1105. DOI: 10.1016/s0015-0282(02)03111-4.
Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from plasma glucose and insulin concentrations in man. Diabetologia 1985;28(7):412–419. DOI: 10.1007/BF00280883.
International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018;33(9):1602–1618. DOI: 10.1093/humrep/dey256.
Solomon CG, Hu FB, Dunaif A, et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. Journal of the American Medical Association 2001;286(19):2421–2426. DOI: 10.1001/jama.286.19.2421.
Sobti S, Dewan R, Ranga S. Metabolic syndrome and insulin resistance in PCOS phenotypes. Int J Reprod Contracept Obstet Gynecol 2017;6(11):5067–5073. DOI: 10.18203/2320-1770.ijrcog 20175027.
Akgul S, Bonny AE. Metabolic syndrome in adolescents with polycystic ovary syndrome: prevalence on the basis of different diagnostic criteria. J Pediatr Adolesc Gynecol 2019;32(4):383–387. DOI: 10.1016/j.jpag.2019.01.006.
Bahadur A, Mundhra R, Kashibhatla J, et al. Prevalence of metabolic syndrome among women with different PCOS phenotypes–a prospective study. Gynecol Endocrinol 2021;37(1):21–25. DOI: 10.1080/09513590.2020.1775193.
Albu A, Radian S, Fica S, et al. Biochemical hyperandrogenism is associated with metabolic syndrome independently of adiposity and insulin resistance in Romanian polycystic ovary syndrome patients. Endocrine 2015;48(2):696–704. DOI: 10.1007/s12020-014-0340-9.
Kar S. Anthropometric, clinical, and metabolic comparisons of the four Rotterdam PCOS phenotypes: a prospective study of PCOS women. J Hum Reprod Sci 2013;6(3):194–200. DOI: 10.4103/0974-1208.121422.
Rashid N, Nigam A, Kauser S, et al. Assessment of insulin resistance and metabolic syndrome in young reproductive aged women with polycystic ovarian syndrome: analogy of surrogate indices. Arch Physiol Biochem 2020;1–8. DOI: 10.1080/13813455.2020.1724157.
Norman RJ, Mahabeer S, Masters S. Ethnic differences in insulin and glucose response to glucose between white and Indian women with polycystic ovary syndrome. Fertil Steril 1995;63(1):58–62. DOI: 10.1016/s0015-0282(16)57297-5.
Altintas KZ, Dilbaz B, Cirik DA, et al. The incidence of metabolic syndrome in adolescents with different phenotypes of PCOS. Ginekol Pol 2017;88(6):289–295. DOI: 10.5603/GP.a2017.0055.
Tavares A, Castro R, Barros R. The prevalence of metabolic syndrome in the different phenotypes of polycystic ovarian syndrome. Rev Bras Ginecol Obstet 2019;41(1):37–43. DOI: 10.1055/s-0038-1676568.
Chan JL, Kar S, Vanky E, et al. Racial and ethnic differences in the prevalence of metabolic syndrome and its components of metabolic syndrome in women with polycystic ovary syndrome: a regional cross-sectional study. Am J Obstet Gynecol 2017;217(2):189.e1–189.e8. DOI: 10.1016/j.ajog.2017.04.007.
Tripathy P, Sahu A, Sahu M, et al. Metabolic risk assessment of Indian women with polycystic ovarian syndrome in relation to four Rotterdam criteria based phenotypes. Eur J Obstet Gynecol Reprod Biol 2018;224:60. DOI: 10.1016/j.ejogrb.2018.02.031.
Karee M, Gundabattula SR, Sashi L, et al. Prevalence of metabolic syndrome in women with polycystic ovary syndrome and the factors associated: a cross sectional study at a tertiary care center in Hyderabad, south-eastern India. Diabetes Metab Syndr 2020;14(4):583–587. DOI: 10.1016/j.dsx.2020.05.006.
Jeengar P, Chauhan M. Association of metabolic syndrome in polycystic ovarian syndrome. International Journal of Geomechanics 2017;3(2):90–94. DOI: 10.21276/obgyn.2017.3.2.5.
Lana MP, Demayo S, Giannone L, et al. Metabolic compromise in women with PCOS: earlier than expected. Rev Assoc Med Bras 2020;66(9):1225–1228. DOI: 10.1590/1806-9222.214.171.1245.
Karamallah SH, Taei S, Safavi E, et al. Incidence of metabolic syndrome in polycystic ovarian syndrome in Iranian women. Int J Med Rev Case Rep 2019;3(8):550–554. DOI: 10.5455/IJMRCR.Incidence-of-metabolic-syndrome-polycystic-ovarian.
Vrbikova J, Vondra K, Cibula D, et al. Metabolic syndrome in young Czech women with polycystic ovary syndrome. Hum Reprod 2005;20(12):3328–3332. DOI: 10.1093/humrep/dei221.
Cheung L, Ma R, Lam P, et al. Cardiovascular risks and metabolic syndrome in Hong Kong Chinese women with polycystic ovary syndrome. Hum Reprod 2008;23(6):1431–1438. DOI: 10.1093/humrep/den090.
Soares EMM, Azevedo GD, Gadelha RGN, et al. Prevalence of the metabolic syndrome and its components in Brazilian women with polycystic ovary syndrome. Fertil Steril 2008;89(3):649–655. DOI: 10.1016/j.fertnstert.2007.03.081.
Bhattacharya SM. Metabolic syndrome in females with polycystic ovary syndrome and International Diabetes Federation criteria. J Obstet Gynaecol Res 2008;34(1):62–66. DOI: 10.1111/j.1447-0756.2007.00685.x.
Varghese J, Kantharaju S, Thunga S, et al. Prevalence and predictors of metabolic syndrome in women with polycystic ovarian syndrome: a study from Southern India. Int J Reprod Contracept Obstet Gynecol 2017;4(1):586. DOI: 10.5455/2320-1770.ijrcog 20150222.
Coviello AD, Legro RS, Dunaif A. Adolescent girls with polycystic ovary syndrome have an increased risk of the metabolic syndrome associated with increasing androgen levels independent of obesity and insulin resistance. J Clin Endocrinol Metab 2006;91(2):492–497. DOI: 10.1210/jc.2005-1666.
Dokras A, Bochner M, Hollinrake E, et al. Screening women with polycystic ovary syndrome for metabolic syndrome. Obstet Gynecol 2005;106(1):131–137. DOI: 10.1097/01.AOG.0000167408. 30893.6b.
Pillai SS, Phukan PK, Dihingia P. Significance of body mass index in the classification of PCOS: a comparative study in Northeast India. J South Asian Feder Obs Gynae 2020;12(3):145–149. DOI: 10.5005/jp-journals-10006-1776.
Talbot EO, Zborowski JV, Sutton-Tyrell K, et al. Cardiovascular risk in women with polycystic ovary syndrome. Obstet Gynecol Clin North Am 2001;28(1):111–133. DOI: 10.1016/s0889-8545(05)70189-3.
Alberti KGMM, Zimmet P, Shaw J. International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med 2007;24(5): 451–463. DOI: 10.1111/j.1464-5491.2007.02157.x.
Malhotra N, Garg R, Rawat A. Polycystic ovarian syndrome: role of nutrition, vitamins, and minerals—myoinositol and vitamin D3. J South Asian Feder Obs Gynae 2020;12(2):63–64. DOI: 10.5005/jp-journals-10006-1757.